Predicting Occurrence of Spine Surgery Complications Using "Big Data" Modeling of an Administrative Claims Database.
Background: Postoperative metrics are increasingly important in determining standards of quality for physicians and hospitals. Although complications following spinal surgery have been described, procedural and patient variables have yet to be incorporated into a predictive model of adverse-event oc...
| Publicado en: | Journal of Bone & Joint Surgery, American Volume Vol. 98; no. 10; pp. 824 - 835 |
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| Autores principales: | , , , , , , , , |
| Formato: | Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
5/18/2016
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=115469319&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 115469319 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00219355 1H2 jtl: Journal of Bone & Joint Surgery, American Volume issn: 00219355 maglogo: N pubinfo: dt: 5/18/2016 vid: 98 iid: 10 pid: 433 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 115469319 115469319 NLM27194492 10.2106/JBJS.15.00301 NLM27194492 115469319 ppf: 824 ppct: 11 formats: tig: atl: Predicting Occurrence of Spine Surgery Complications Using "Big Data" Modeling of an Administrative Claims Database. aug: au: Ratliff, John K. Balise, Ray Veeravagu, Anand Cole, Tyler S. Ivan Cheng Olshen, Richard A. Lu Tian Cheng, Ivan Tian, Lu affil: Investigation performed at Stanford University School of Medicine, Stanford, California sug: subj: Spine Surgery Postoperative Complications Epidemiology Data Mining Methods Resource Databases United States Male Risk Assessment Adult Female Models, Statistical Middle Age Adult: 19-44 years Middle Aged: 45-64 years Male Female ab: Background: Postoperative metrics are increasingly important in determining standards of quality for physicians and hospitals. Although complications following spinal surgery have been described, procedural and patient variables have yet to be incorporated into a predictive model of adverse-event occurrence. We sought to develop a predictive model of complication occurrence after spine surgery.Methods: We used longitudinal prospective data from a national claims database and developed a predictive model incorporating complication type and frequency of occurrence following spine surgery procedures. We structured our model to assess the impact of features such as preoperative diagnosis, patient comorbidities, location in the spine, anterior versus posterior approach, whether fusion had been performed, whether instrumentation had been used, number of levels, and use of bone morphogenetic protein (BMP). We assessed a variety of adverse events. Prediction models were built using logistic regression with additive main effects and logistic regression with main effects as well as all 2 and 3-factor interactions. Least absolute shrinkage and selection operator (LASSO) regularization was used to select features. Competing approaches included boosted additive trees and the classification and regression trees (CART) algorithm. The final prediction performance was evaluated by estimating the area under a receiver operating characteristic curve (AUC) as predictions were applied to independent validation data and compared with the Charlson comorbidity score.Results: The model was developed from 279,135 records of patients with a minimum duration of follow-up of 30 days. Preliminary assessment showed an adverse-event rate of 13.95%, well within norms reported in the literature. We used the first 80% of the records for training (to predict adverse events) and the remaining 20% of the records for validation. There was remarkable similarity among methods, with an AUC of 0.70 for predicting the occurrence of adverse events. The AUC using the Charlson comorbidity score was 0.61. The described model was more accurate than Charlson scoring (p < 0.01).Conclusions: We present a modeling effort based on administrative claims data that predicts the occurrence of complications after spine surgery.Clinical Relevance: We believe that the development of a predictive modeling tool illustrating the risk of complication occurrence after spine surgery will aid in patient counseling and improve the accuracy of risk modeling strategies. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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